Stanislaus County forums offer help with Medicare program changes expected in 2026

About 300 people attended a Modesto forum Friday to hear about changes to the federal Medicare program starting in January.

UnitedHealthcare announced recently it was discontinuing a long-standing Medicare Advantage HMO in Stanislaus County, effective Jan. 1. There’s also concern the fallout from federal Medicare spending cuts next year will result in rate increases or decisions by insurers about their plans in the county.

Once called Secure Horizons, the AARP United Healthcare HMO provided access to Sutter Health physicians and medical facilities, as well as other physicians. Sutter notified about 4,100 members of the UnitedHealthcare plan to change insurance if they want to keep their Sutter physicians and medical services.

Advisers at the forum said it’s a good idea to pay close attention to Medicare developments this fall. The UnitedHealthcare Medigap (supplemental insurance) plan is staying put in this county and there’s no change to an employer-provided United Healthcare plan for retirees.

The Modesto forum was held by the Health Insurance Counseling and Advocacy Program. People can sign up for Medicare or make changes to coverage during an enrollment period from Oct. 15 to Dec. 7.

HICAP representatives said people affected by changes in 2026 can talk with a trusted independent insurance broker about their Medicare coverage. The HICAP office in Modesto, at 3500 Coffee Road, Suite 19, also makes appointments to assist county residents with navigating the Medicare system for adults 65 or older and certain disabled people. HICAP has staff and volunteers who speak several different languages.

In Stanislaus County, eight insurers have Medicare Advantage plans in 2026.

Sutter Health, owner of Memorial Medical Center, notified affected patients this month that it accepts other Medicare Advantage plans in Stanislaus County, including Alignment Health My Choice PPO, costing $77 per month, and Sutter Senior Advantage, a SCAN Medicare Plan HMO with a $49-a-month premium.

Sutter also accepts a Health Plan of San Joaquin Advantage HMO, which is a special-needs plan for low-income patients eligible for both Medicare and Medi-Cal. Acceptance of the Health Plan of San Joaquin HMO is limited to established patients.

Alignment Health has Medicare plans with access to AllCare physicians, Doctors Medical Center and Turlock’s Emanuel Medical Center, including AllCare Preferred with a zero monthly premium. Alliance also offers Smart HMO and Honor Plan HMO, both with no monthly premium.

Representatives of other insurers at the forum gave an outline of their Medicare plans: * Blue Shield of California has the Inspire HMO, for $58 a month, with access to AllCare, Doctors and Emanuel. * Anthem Blue Cross Prime is another zero-premium plan. It contracts with Central Valley Medical Group, Doctors, Emanuel and Memorial hospitals. * Central Health Medicare Plan charges no premiums for Classic Care Plan III HMO. It contracts with Central Valley Medical Group, Doctors, Emanuel and Memorial. * Humana offers Gold Plus HMO and USAA Honor Giveback, both at no monthly cost. * Imperial Health Dynamic HMO includes AllCare, Doctors, Memorial, Oak Valley Hospital and Emanuel. No monthly cost. * Kaiser Permanente Senior Advantage is another longstanding plan. The basic plan will cost $19 a month next year; Senior Advantage Enhanced will cost $85 a month. * In addition to Sutter Senior Advantage, SCAN Health has a Classic HMO for no monthly cost with access to AllCare, Central Valley Medical Group, Doctors and Emanuel.

In comparing the plans, people should consider the copays for physician visits, hospitalization, emergency room care, surgeries and prescription drugs and also the annual out-of-pocket maximum cost. According to a comparison sheet, all the plans in this county include dental, vision and hearing benefits. HICAP advises seniors to make sure the health plan covers their prescription drugs.

Some plans cover transportation, others do not.

Medigap is another way to cover health costs not covered by original Medicare, which pays 80%. Monthly premiums are often higher for Medigap, which allows more freedom to choose physicians than with managed-care plans. Some high-deductible plans are sold.

HICAP stresses that prescription drugs are not covered by supplement plans.

The Turlock Senior Center, 1191 Cahill Ave., will host a Medicare forum at 1 p.m. Oct. 27. A HICAP forum is set for Oct. 21 at 1 p.m. at the Gladys Lemmons Senior Center, 450 E. A St. in Oakdale. Stanislaus County HICAP can be reached at 209-558-4540.

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